The meaningful use program has had and continues to have its challenges, but much has been accomplished, and much will be accomplished over the next two years as well; and a bold future of data-driven healthcare is ahead of us. That was the core of the keynote presentation delivered by David Blumenthal, M.D., at the Health IT Summit in New York, held at the Convene conference center in New York City’s Financial District Sep. 28-30, and sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics, under the corporate umbrella of parent company Vendome Group, LLC).
Dr. Blumenthal, who is now president of The Commonwealth Fund, the New York City-based organization whose website describes it as “a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults,” served as National Coordinator for Health IT in 2009-2011. He spoke on the topic, “Realizing the Potential of Health IT: The Policy Challenge, on Sep. 30, at the Convene conference center in the city’s Financial District.
David Blumenthal, M.D.
At the outset of his remarks, Blumenthal noted a number of statistics, including the following: $31.13 billion was disbursed between May 2011 and May 2015, to 470,000-plus unique providers, slightly under the estimate made by federal officials of $34 billion in disbursements prior to the onset of the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical Health) Act.
Blumenthal, using statistics from the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS), also noted that 95 percent of eligible hospitals and 54 percent of all office-based physicians in the U.S., have received Medicare or Medicaid incentive payments so far; and that as of July 2015, 1,836 eligible hospitals, and 60,004 eligible providers, had attested to Stage 2 of meaningful use.
With regard to the qualitative evaluation of the meaningful use program to date, Blumenthal said, “With respect to Stage 2, clearly, the hurdle is higher” than it was under Stage 1 of meaningful use. “We’ve had 1800-plus hospitals attest. It doesn’t prove that it’s easy, but it does prove that it’s possible.”
Further, he noted, “Stage 2 ended up emphasizing interoperability, decision support and consumer engagement. If you think about the value of electronic health records, they don’t lie in the capture of data, but in their use, including exchanging information, supporting clinical decision-making, and enabling clinicians to be more effective partners with patients in their care.”
Anticipating the final rule for Stage 3 of meaningful use, Blumenthal noted that “The proposed Stage 3 rule is now before OMB”—the federal Office of Management and the Budget. “It’s always dangerous to predict based on a proposed rule, what a final rule will look like.” That said, he noted that the proposed rule for Stage three “continues the emphasis on interoperability, consumer engagement, and decision support. What it will actually look like when OMB is finished with it, and ONC and CMS have finished with it, I don’t know,” he said. “But what is clear is that there will be no stages after 2017. When we were first tasked with defining meaningful use in 2009, there was no literature to go on, and no definition,” he added. “The conceptual basis for defining it was pretty much a null set. And the reason for multiple stages was to allow the definition to evolve. If we had tried to set out a final definition in Stage 1, it would almost certainly have been wrong, constraining, and impractical. So the idea that we’ve continued to redefine meaningful use has been gratifying.”
He also noted the dramatic leaps in the adoption of electronic health records (EHRs) because of the passage of the HITECH Act, with its meaningful use program. As he noted, hospitals’ adoption of EHRs went from 9 percent in 2008, according to his accounting, to 76 percent in 2014, while physician practices’ adoptions of electronic health records went from 29 percent of physician practices having adopted any kind of EHR in 2006, to 83 percent having done so by 2014.
The Challenge of Health Information Exchange
“What are the continuing challenges?” for clinical information system adoption, Blumenthal asked his audience rhetorically. “Health information exchange remains a continuing challenge,” he stated. Meanwhile, he said, “Interoperability, which is technical,” also remains to some extent unresolved. Among the challenges he sees in the forward evolution of health information exchange adoption, Blumenthal told his audience, are HIE governance, which he described as still “haphazard”; as well as data privacy and security concerns; and the fact that “Electronic health records weren’t designed effectively with [clinical] end-users in mind.”